Hernia is a very common disorder
and affects about 2% of the population; hence it is important
for all to have basic knowledge of this problem, its symptoms
and treatment.

It can occur in males as
well as females but it is more common in males. Hernia can
occur at any age, from cradle to grave; it may be seen in
a newborn child as also in a very old person. Every Hernia
needs immediate detection by medical expert, proper and detailed
diagnosis followed by proper treatment.

Hernia occurs mainly through
abdominal wall.

External Hernia can usually
be observed on abdominal wall while Internal Hernia occur
within the abdomen and can't be seen on abdominal wall.

Definition :

It is a protrusion of Intestine
/ Abdominal fat ( Omentum ) / urinary bladder, commonly through
an abnormal or abnormally large normal opening in the muscle
wall of the abdomen. Seen as a Swelling, which may not be
painful all the time. Swelling appears on straining and coughing
and may disappear on lying down.

Patient suffering from hernia
gets abnormal swelling due to protrusion of abdominal content,
mostly small or large intestine, abdominal fat called omentum
or sometimes urinary bladder in older people. This protrusion
occurs through an opening or weakness in muscle wall of the
abdomen. Hernia can be reducible or irreducible; it may disappear
if reducible and reappear in erect position or on straining
and coughing. Reduction may be spontaneous i.e. content of
the Hernial sac may return unaided to the abdominal cavity
when patient lies flat on his back. However if the patient
remains untreated a reducible Hernia may become irreducible
i.e. content of the sac does not return to the abdominal cavity.
Irreducibility may be caused by the increase in the size of
the Hernia, formation of adhesions or relatively tight Hernia
ring (defect in the wall of the abdomen). Irreducible Hernia
is a constant source of danger, as it may result into obstruction
or strangulation. Such Hernia needs immediate surgical operation.

Hernia can occur at
various sites on the abdomen. The commonest sites in
90% cases is groin i.e. lowest part of the abdomen,
just above the thigh on the right or the left or both
the sides. It is more common in male, the ratio between
males and females being as high as 25:1.

Yes, it is mandatory. For
treatment of Hernia, surgery is the only remedy. There was
never, there isn't, and there may not be in future any treatment
for Hernia other than surgical operation. Delay in operation
can result into enlargement of Hernia or may cause complication
like obstruction or strangulation resulting into gangrene
of a part of the intestine, which is a life - threatening
condition.

Who
can be operated :

Operation can be performed
at any age from newly born child to a centurion i.e.
person as old as 100 years.

The author has on record
several patients above the age of 90 yrs who have been
operated for Hernia and returned home on the same day.

There wasn't, there isn't
& there may not be any treatment of Hernia except Surgical
Operation of Repair.

Various Methods of Repair
are

Tissue Repair ( without using mesh )

Hernial sac is removed and the gap is closed
by approximation of muscle in the region(conjoint tendon)to
the inguinal ligament.Various methods like Bassini's,Shouldice's
repair aer well known recurrence rate is slightly higher then
mesh repair.

How
does a mesh help ?

It provides a physical barrier
to the intestines and abdominal fat preventing the same from
protruding. Body tissues grow through the mesh and allow the
fixation of the mesh to the surrounding area, thereby preventing
the recurrence of the Hernia.

If the mesh is not properly
fixed in its position it may lead to recurrence of Hernia.
This type of surgery should be performed in an operation theatre
having most aseptic atmosphere to avoid the chances of infection
and hence the recurrence of Hernia.

What
is PHS ?

It is a dual mesh joined
to each other by a connector, and is made up of prolene (
Polypropylene), hence named the Prolene Hernia System (PHS).
It was designed by American Surgeon Dr.Arthur Gilbert of South
Miami Hospital , Florida , USA . The operation of Hernia using
PHS was first described by Dr. Arthur Gilbert.

It is technically an excellent
mesh and has the following indications for its use:

Old age patients,

Patients with risk factors,(refer to risk
factors)

Weak patients,

Persons engaged in strenuous work,

Obese persons,

Immuno compromised patients and

Patients having large Hernia.

PHS provides comprehensive
repair for Indirect, Direct, Femoral & Lateral triangle
Hernias. It is also used for umbilical, paraumbilical, small
incisional and epigastric Hernias. The recovery after the
use of this mesh is excellent and with negligible post – operative
pain.

In our clinic most of the
groin Hernia & small type other hernias are operated under
local anesthesia.

What
anesthesia is administered for Hernia operation ?

Most of the cases are operated
under local anesthesia. It is very safe and generally without
any complication. Patients are comfortable during the surgery
and are found talking with the surgeon while the surgery is
in progress. On completion of the surgery patient gets up
from the operation table and starts walking on his own.

There are no side effects
like nausea or vomiting, which allows the patient to resume
his diet immediately with tea/snacks and followed by regular
meals.

This technique is also safe
for cardiac patients and other high-risk patients. Old age
patients are safely operated under local anesthesia &
are able to return home the same day.

Patient
comes out of Operation Theatre Walking and is having
tea soon after. He is 92yrs. of age

Important
requirements in Hernia Operations

Technique
Selecting appropriate technique of operation by the surgeon
for each patient i.e. Tissue or Mesh Repair or PHS, Kugal
Mesh is of paramount importance.

Technician(i.e.
Surgeon)
Surgeon performing the operation should be well experienced
in the procedure, has the ability to select the best technique
and has innovative ideas. A combination of all these qualities
with full co-operation and compliance by the patient brings
excellent results in Hernia surgery.

Success
Rate

Modern treatment of various
types of Hernia in general and Groin Hernia in particular
is so designed that the success rate has reached almost 99.7%.
Recurrence is rare and local anesthesia complications are
unknown in the hands of dedicated expert Hernia surgeon performing
surgery under strict aseptic precautions.

GROIN
HERNIA

Our Surgeon is Ambulatory
Hernia Surgeon .

Surgical gastoenterologist,
has experience of 36 years in surgery and 25 years in modern
hernia surgery under local anesthesia.

Over last 25 years he has
performed large number of hernia operations using various
techniques depending on the type of hernia, patient's occupation,
associated other disease and age group, with local anesthesia,
With excellent results.

Are very well repaired using
local/spinal/general anaesthesia. Most of these repairs are
performed by using appropriate mesh.

Abdomino plasty
+ Abdominal hernia

Larger type of abdominal
hernia with lot of fat on the abdomen and lax abdominal muscles
are suitable cases for this type of repair in which not only
hernia repair is achieved but also reduction of the pot belly
with tightening of the muscles is achieved.